swallowing disorders and maintaining nutrition Flashcards
Why is swallowing important?
(McBean and Wijck, 2012).
- allows us to eat and drink safely
- nutrition
- hydration
- social- many social activities revolve around eatings and drinking, therefore impaired social contact
What is dysphagia and how is it caused?
(McBean and Wijck, 2012).
eating, drinking, and swallowing problems
often caused as a conseqeuce of neurological diseases e.g. stroke, demenita, Parkinson’s, motor neurone disease, MS. Stroke is the biggest cause (90%)
damage to the strctures of mouth and pharynx, sensory and motor nerves supplying these areads and associated muscles or control centers in brain
What are some problems associated with dysphagia?
(McBean and Wijck, 2012).
- poor QoL
- choking
- aspiration
- drooling
- chest infections- due to aspiration
- delayed recovery due to malnutrition and dehydration
- breakdown of skin- due to drooling
What are the structures of the mouth and oral cavity?
(McBean and Wijck, 2012
- lips
- teeth
- tongue
- hard and soft palate
- pharynx
- larynx
-oesophagus
Describe the oral phase of swallowing.
(McBean and Wijck, 2012).
- food and liquid are consciously manipulated in the mouth
- food is put into the moth, broken down via chewing, mixed with saliva, and held forward by the tongue
- then the food travels back along the tongue, being squeezed and rolled, passing through the pharynx into phase 2
- this phase needs normal muscle tone and control, without this spillage can happen
- voluntary phase
Describe the pharyngeal phase of swallowing.
(McBean and Wijck, 2012).
- a series of reflex controlled movements direct the food into the oesophagus and protect the airways
- sensory stimulation of tonsillar pillars excite sensory nerves feeding back to swallowing centers in the brain.
- this then excited motor nerves, controlling muscles associated with the pharynx and larynx, initating the swallowing reflex
Describe swallowing difficulties.
(McBean and Wijck, 2012).
- can arise if there is a delay or failure in reflex movements meaning food may enter the airways or escape from the mouth
- ## takes longer to swallow as we age due to a delay in triggering. not normally an issue but if there is addional neurological damage food may be aspirated into the airway causing choking and infection.
Describe the role of a speech and language therapist (SLT)?
(Martin et al, 2014).
- assess ability of pateints to swallow
- may suggest exercises to improve swallowing
- may make it easier to feed by modifying texture of the food, usually thickening it
- if these options dont work then they may implement an NG (nasogastric) tube for short term or PEG (percutaneous endoscopic gastromy) for long term
- NG and PEG tube solves the issue of nutrition but mouth care must be carried out and hydrated to protect the airways
How does aging affect malnutrition?
(Amarya, 2015)
- malnutrition is a cause and consequence of ill health. it also reduced appetite
- elderly population has increased likliehood of weakend immune system, infections, poor wound healing, and muscle weakness leading to falls and frailty.
- lack of physical activity, poor appetite, feeling of unwantedness, sense of neglect all present in the elderly leading to decreased interest in eating
How does demenita and the swallowing difficulties associated with it affect patients?
(Martin et al, 2014).
- certain types of dementia can cause taste and smell impairments, putting people off food
- dementia decreases interest and motivation in eating also temporal confusion can cause people to be confused on whether theyve eaten or not
- muscle weakness, tremor, reduced coordination and slowness make preparing, cooking, and eating food difficult.
- in later stages difficulties with feeding, chewing, and swallowing are often seen which may impact nutruional status.
What is a MUST assessment?
(Martin et al, 2014).
- 5 step scale, used by health professionals
- first three steps evaluate BMI, whether there has been involuntary weight loss during last 3-6 months, and detecting if there has been inadequate food intake in the past 5 or more days due to acute illness.
- step 4 by summing the scores in steps 1-3, the person is classed as low, mid, or high risk of malnutrition
- the fifth step consist of management guidelines for setting an appropriate care plan
- after a MUST assessment is carried out an in-depth evaluation should be carried out investigating nutritional habits, physical activity, and body function.
How does diet affect cognitive functioning?
(Martin et al, 2014).
- many studies show that adherance to diets based on healthy policy guidelines might be associated with improved cognitive functioning
- mediterannian diet has the largest body of evidence support it in the reduction of cognitive decline and is assocoaited with. reduced risk of Alzheimer’s disease.
What is the WHO model of ICF (International Classification of Functioning, Disability, and Health)?
(WHO, 2002).
- framework, integrating both medical and social models of disability. it consisits of two main components:
functioning and disability: - focuses on an individual’s functioning and disability in relation to their body functions and structures, activities they perform, and participation in society
- recognises health and disability arens just determined by medical conditions but also by environmental and personal factors.
contextual Factors: - considers environmental factors (such as physical, social, and attitudinal environments) and personal factors (such as age, gender, coping styles, and other individual characteristics) that can influence an individual’s functioning and disability.
The ICF model provides a comprehensive framework for understanding health and disability from a holistic perspective, emphasizing the interaction between an individual’s health condition and their environment. It’s widely used in healthcare, rehabilitation, policy-making, and research to promote a more inclusive and person-centered approach to health and well-being.
